426

THEORY AND METHODS

Conceptualisation, development, and evaluation of a

measure of unplanned pregnancy
G Barrett, S C Smith, K Wellings
...............................................................................................................................

J Epidemiol Community Health 2004;58:426–433. doi: 10.1136/jech.2003.014787

Study objective: To develop a measure of unplanned pregnancy that is valid, reliable, and appropriate in
the context of contemporary demographic trends and social mores and can be used in a variety of
situations, including the production of population prevalence estimates.
Design: A two stage study design: qualitative (inductive) methods to delineate the construct of pregnancy
planning, and quantitative/psychometric methods to establish the means of measurement.
Setting: Eight health service providers (comprising 14 clinics, including antenatal, abortion, and one
See end of article for general practitioner) across London, Edinburgh, Hertfordshire, Salisbury, and Southampton in the UK.
authors’ affiliations Participants: Samples comprised a mixture of pregnant (continuing pregnancy and opting for abortion)
.......................
and recently pregnant (post-abortion and postnatal) women. At the qualitative stage, 47 women took part
Correspondence to: in depth interviews (20 of whom were re-interviewed after the birth of their baby). Items were pre-tested
Dr G Barrett, Department with 26 women, and two psychometric field tests were carried out with, respectively, 390 and 651 women.
of Health and Social Care, Main results: A six item measure of unplanned pregnancy was produced. Psychometric testing
Brunel University, Borough
Road, Middlesex TW7 demonstrated the measure’s high reliability (Cronbach’s a = 0.92; test-retest reliability = 0.97) and high
5DU, UK; geraldine. face, content, and construct validity. Women’s positions in relation to pregnancy planning are represented
barrett@brunel.ac.uk by the range of scores (0–12).
Accepted for publication
Conclusions: A psychometric measure of unplanned pregnancy, the development of which was informed
10 December 2003 by lay views, is now available. The measure is suitable for use with any pregnancy regardless of outcome
....................... (that is, birth, abortion, miscarriage) and is highly acceptable to women.

T
he concept of ‘‘unplanned pregnancy’’ is widely used in
health research and policy. Attempts to measure it have
been numerous, varying from studies in which the
concept is assumed to be self evident to those in which more
sophisticated measurement strategies have been used.1–5 The
approach taken by large national surveys has tended towards
the latter, eliciting planning status by means of multi-
dimensional questions, probing (in various combinations)
intentions, contraceptive use, reactions to pregnancy, timing
of pregnancy plans, and family size intentions.6–12 The most
influential of these surveys has been the US National Survey
of Family Growth12 whose forms of measurement have been
widely adopted.13–15
In recent years, however, there has been growing aware-
ness of the limitations of existing questions.5 16–21 No new
estimates of unplanned pregnancy have been produced in
Britain since 1991, and in the US National Survey of
Family Growth items have been added incrementally to
ensure validity.12 22 As most questions currently used to
assess unplanned pregnancy were developed several
decades ago, before legal abortion was available and when
the primary concern was with excess fertility in marital
relationships,20 it is not surprising that such questions are
becoming dated. Also, as therapeutic advances have effec-
tively raised the upper age limit for pregnancy and as
employment opportunities have increased for women, the
social context of childbearing has changed. Furthermore,
measurement to date has tended to assume congruence
between intentions and behaviour despite evidence to the
contrary.4 6 7 17
Calls are now being made for a reconsideration of the
conceptual basis of unplanned pregnancy.17–19 Improvements
to the yield of national fertility surveys will only come, it is
said, from ‘‘intensive work to refine the measurement of
often elusive concepts’’.10 In this spirit we began a three year
study in 1998 to develop a new measure of unplanned
pregnancy for use in Britain. We describe here the develop-
ment and psychometric validation of the measure.
METHODS
The overall aim of the study was to develop a measure of
pregnancy planning/intention that is valid, reliable, and
appropriate in the context of contemporary demographic
trends and social mores, and can be used to establish
population estimates of unplanned pregnancy. To achieve
this we used a two stage study design: (1) qualitative
methods to delineate the construct of pregnancy planning;
and (2) quantitative/psychometric methods to establish the
means of measurement.
Conceptualisation
To develop a conceptual model of pregnancy planning/
intention, we used depth interviews (that is, flexible inter-
views that use normal modes of conversation) to elicit
women’s accounts of the circumstances in which they
became pregnant. The aim was to build a model based on
the key elements of the interviews through which an
understanding of women’s experiences could be gained.
(Details of the methodology and qualitative findings have
previously been reported.23 24)
As previous evidence had suggested that answers elicited
before and after birth may be different,25 26 we conducted
follow up interviews with women who continued their
pregnancies after they had their babies. The aim was to
assess if, or how, women’s accounts changed over this time
period
Item development and piloting
The conceptual model produced during the qualitative stage
informed item development; items were developed, without

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New measure of unplanned pregnancy
limit, until the dimensions of the model were adequately
represented. The items were piloted with a small sample of
women and qualitative interviews were used to check
women’s understanding. Amendments to the items were
made incrementally during piloting.
Item analysis and selection (first psychometric field
test)
We screened items for homogeneity27 using inter-item
correlations and Cronbach’s a.28 We then devised a five step
strategy for item analysis and selection: (1) Remove items
with more than 5% missing data29; (2) Remove any item with
a maximum endorsement frequency of >80% on any
response option30 31; (3) Remove any item with an item-total
correlation of ,0.230 31; (4) Rank the remaining items
according to the item-total correlations and then, starting
with the lowest rank, remove items if they correlate
highly (that is, .0.75) with another question27 30–32; (5)
Return items to the scale, in reverse order of removal, until an
a of .0.90 is reached.27 32 (Although a criterion of 0.7 is often
cited for internal consistency, we used a more stringent
criterion to allow for the possibility that the Cronbach’s a
might be lower in future samples.27 32) The strategy enabled
us to maximise homogeneity while still maintaining content
validity.
Evaluating the item reduced measure (second
psychometric field test)
A second independent field test was carried out to establish
the psychometric properties of the final, item reduced,
measure (appendix, available to view on the journal web
site http://www.jech.com/supplemental).
Before analysis, missing data from this field test were
imputed for the 18 women with missing data using the
method applied to the SF-3633 (that is, where a subject has
completed at least 50% of items of a scale, the mean score of
their completed items can be substituted for the missing
items).
Acceptability of the measure
Acceptability was assessed by examining rates of missing
data for the overall score and the distribution of scores. The
reading level of the measure was assessed using the Flesch-
Kincaid grade level scale.34 Field notes were kept by
researchers of women’s experiences of completing the
measure; notes were based on the researchers’ observations
and informal questioning of women in clinics.
Reliability
Internal consistency was assessed using the Cronbach’s a
statistic (.0.7 indicating acceptable reliability28 35), and test-
retest reliability was examined in two ways: (1) a standard
test-retest where a sub-sample of women were required to
complete the repeat measure 7 to 14 days after first
completion (an interval comparable to that used for other
measures31); and (2) a long term test-retest that only
included women who had completed the measure initially
when they were pregnant, and then completed the repeat
measure some months later, after the birth. The rationale for
this second test was to assess the stability of scores before
and after birth in light of existing evidence which suggests
that women’s reporting is unstable over this period.25 26 In
both instances, test-retest reliability was measured using the
weighted k (the non-parametric equivalent of the intra-class
correlation coefficient), a score of 0.61–0.80 indicating
‘‘substantial’’ reliability and .0.80 indicating ‘‘almost per-
fect’’ reliability.36
427
Validity
Content validity was assessed by comparing items in the final
item reduced instrument with the conceptual model.
Two methods were used to assess construct validity:
principal component analysis for within scale analyses; and
hypothesis testing. We used principal component analysis
(using varimax rotation and requesting as many factors as
there were eigenvalues .1) to test the hypothesis that all
variables would load onto one factor.37 For hypothesis testing
there were two levels of hypotheses, from the qualitative
findings and from the literature (table 1).
Although construct validity is also sometimes tested by
considering the relation between the new measure and an
established measure of a similar construct (convergent
validity) or with a known measure of a different construct
(discriminant), not enough is known about the nature of the
construct of ‘‘pregnancy planning’’ to enable these hypoth-
eses to be formulated. Criterion related validity is usually
established by comparing a new psychometric measure with
an established measure (ideally a ‘‘gold standard’’) of the
same construct. However, as the absence of an existing
measure was the reason for developing this measure, testing
(concurrent or predictive) criterion related validity was also
not possible. Responsiveness refers to an instrument’s ability
to detect change (over time) in a dynamic construct (for
example, change in health status); as conception is an event
at one point in time and therefore not a dynamic construct,
testing responsiveness was not appropriate.
Interpreting the scores
Interpretation of scores is normally an ongoing process over
the life of a measure. As a first step in this process, we used a
content based method of interpretation,38 using the item
score patterns in the second field test and data from the
qualitative stage, to provide the contextual detail necessary
for initial interpretation of the scores.
Sampling
As we aimed to develop a measure that could be used to
produce population estimates, women who were (or had
been) pregnant were our target population. Although many
men clearly have an important role in pregnancy planning,
we did not include them on the grounds that not all men
know about the pregnancies of their partner (or ex-partner),
and because relying on information collected from couples,
rather than women alone, would introduce substantial biases
into a population sample.
All samples were constructed to include women of all ages
whose pregnancies were continued and those which ended in
abortion. Recruitment of study participants was from eight
health service providers (comprising 14 clinics, including
antenatal, abortion, and one general practitioner) across
London, Edinburgh, Hertfordshire, Salisbury, and
Southampton in the UK.
The qualitative sample was purposively sampled according
to the above criteria, and for follow up, all women who were
eligible and could be contacted were re-interviewed. The
pilot/item development sample was also purposively sampled.
As psychometric field test samples must reflect the
populations for whom the measure is designed,27 30 un-
selected clinic populations were invited to take part until the
ratio of abortions to live births in the samples was consistent
with that in the national population39–42 (that is, abortions
comprise 22% of conceptions). Women who were continuing
their pregnancy or opting for abortion were recruited in
hospital clinics. Three researchers (led by GB) carried out the
recruitment. Women were approached directly by the
researcher in a waiting room or a side room at some time
during their appointment; only occasionally women declined
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428 Barrett, Smith, Wellings

Table 1 Construct validity hypothesis tests

Score range Mean Significance test
Hypothesis Variable (median) rank and p value

Level 1: Strong hypotheses from qualitative findings:

Higher scores will be associated Pregnancy outcome:
with continued pregnancies and continued pregnancy 0–12 (11) 393.53 Mann-Whitney U,
lower scores with pregnancies abortion 0–12 (2) 98.48 p,0.0001
ending in abortion.
‘‘Living with husband’’ status Marital status/live with:
will be associated with higher husband 0–12 (11) 431.83 Kruskal-Wallis,
scores, other categories partner 0–12 (6) 283.25 p,0.0001
associated with lower scores. not husband or partner 0–12 (2) 145.68
Older age will be associated Age group:
with higher scores (although ,20 0–12 (3) 154.90 Kruskal-Wallis,
the full range of scores likely 20–24 0–12 (4) 240.18 p,0.0001
on all ages). 25–29 0–12 (9) 307.57
30–34 0–12 (11) 398.96
35–39 0–12 (11) 397.37
40+ 0–12 (10) 365.29
Higher educational status will Educational level:
be associated with higher school 0–12 (6) 278.92 Jonckheere-
scores (although full range of post 16 0–12 (7) 297.97 Terpstra,
scores likely for all levels of higher/further 0–12 (11) 367.32 p,0.0001
educational status).
Level 2: Hypotheses from the literature, neither proved nor
disproved by qualitative findings:
Black women will have lower Ethnicity:
scores. White British 0–12 (10) 335.59 Kruskal-Wallis,
White other 1–12 (10) 331.37 p = 0.013
Asian/Asian British 1–12 (10) 331.63
Black/Black British 0–12 (5) 246.75
Mixed/other 1–12 (8) 272.32
The second child (actual births) Child order:
will have the highest scores, Continued pregnancies only:
and the third-plus child lowest was/will be first child 1–12 (10) 251.09 Kruskal-Wallis,
scores. was/will be second child 1–12 (11) 283.62 p,0.0001
was/will be third or more child 0–12 (9) 197.32

to participate. Postnatal women were recruited in two ways.
Firstly, women (14 in first field test and 170 in second field
test) were identified from records of recent births at the
participating hospitals and were sent the questionnaire via
post; response rates were 79% (11) and 67% (112) respec-
tively. Secondly, postnatal women were recruited at commu-
nity clinics run by health visitors. Sample sizes complied with
guidance.43
For the test-retest samples, women were invited to
volunteer to complete a second questionnaire at home.
Because of issues of confidentiality (particularly the problem
of sending material about pregnancy to women’s homes),
women undergoing abortion were excluded from this
process, and therefore from the standard test-retest. Of the
467 women invited to participate, 340 (73%) agreed. For both
test-retests, 121 women were selected (on a quota basis to
include a range of ages) to achieve the sample sizes necessary
for repeated observations.44
Ethical approval
Multi-centre ethical approval was obtained for the study.
RESULTS
Samples
The qualitative sample comprised 47 women: 28 were
continuing their pregnancies (although one had a miscar-
riage a couple of days before the interview), two were about
to have abortions, and 17 had recently had abortions, most
within the past two weeks. Women’s ages ranged from 15 to
43. Women’s educational and occupational levels and
marital/relationship situations varied widely.
Of the 27 women in the qualitative sample who subse-
quently had a baby, 20 were re-interviewed. One declined an
interview and six could not be recontacted. The mix of ages
and personal circumstances in the sample was, however,
maintained. At the time of follow up, the infants’ ages ranged
from two to six months, and the time between interviews
was seven to ten months.
Twenty six women, aged 16 to 42, took part in the piloting
of the items. Seventeen were continuing their pregnancies,
five were about to have abortions, and six had had babies in
the past three months.
Altogether 390 women took part in the first field test
and 651 in the second field test. Table 2 shows the
characteristics of both field test samples. The samples were
consistent with national data in terms of birth/abortion ratio
and were largely consistent in terms of age distribution and
marital status, although women born abroad were slightly
over-represented45–47 (table 3).
Ninety eight women (81%) completed the repeat measure
for the standard test-retest; 90 (74%) were in the seven to
14 day window eligible for analysis.
Ninety women (76%) completed the repeat measure for the
long term test-retest; 87 (72%) were eligible for analysis.
(Two women had become pregnant again and one woman
was still pregnant at 39 weeks). The interval between the two
questionnaires was six plus months for most women.
Conceptualisation
The circumstances in which women became pregnant
are summarised by six thematic areas: (1) expressed
intentions; (2) desire for motherhood; (3) contraceptive
use; (4) pre-conceptual preparations; (5) personal circum-
stances/timing; and (6) partner influences. These areas
formed the dimensions of the conceptual model (fig 1). The
model reflects the complexities of women’s accounts by

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New measure of unplanned pregnancy 429

Table 2 Characteristics of the women in the psychometric field test samples

Field test 1 Field test 2

Variable % (n) % (n)

Pregnancy situation n = 390 n = 651

continuing pregnancy* 63.8 (249) 47.3 (308)
abortion 18.5 (72) 22.9 (149)
postnatal` 17.7 (69) 29.8 (194)
Age n = 385 n = 648
under 20 7.0 (27) 11.8 (77)
20–24 13.5 (52) 15.6 (101)
25–29 24.4 (94) 21.0 (136)
30–34 29.6 (114) 30.1 (195)
35–39 20.8 (80) 17.7 (115)
40+ 4.7 (18) 3.7 (24)
range 14–47 14–47
Number of children n = 388 n = 651
0 37.4 (145) 37.5 (244)
1 34.8 (135) 36.1 (235)
2 19.1 (74) 17.8 (116)
3 5.7 (22) 5.7 (37)
4 2.1 (8) 1.5 (10)
5+ 0.8 (4) 1.4 (9)
Who women live with n = 387 n = 651
husband 55.6 (215) 50.4 (328)
partner 20.9 (81) 19.8 (129)
husband and parents 2.6 (10) 2.0 (13)
partner and parents 1.8 (8) 2.3 (15)
parents 5.1 (20) 9.5 (62)
alone 9.5 (37) 10.0 (65)
other relatives or friends 4.1 (16) 4.3 (28)
other 0.3 (1) 1.7 (11)
Woman’s place of birth n = 388 n = 648
Britain 73.5 (285) 77.6 (503)
elsewhere 26.5 (103) 22.4 (145)
Ethnicity n = 389 n = 650
White
white British 65.0 (253) 71.7 (466)
white Irish 3.1 (12) 2.3 (15)
white other 9.5 (37) 8.9 (58)
Mixed
mixed—white and black Caribbean 0.5 (2) 0.6 (4)
mixed—white and black African 0.5 (2) 0.2 (1)
mixed—white and Asian 0.5 (2) 0.6 (4)
mixed-other 0.8 (3) 0.3 (2)
Asian
Asian—Indian 2.1 (8) 1.4 (9)
Asian—Pakistani 1.8 (7) 4.5 (10)
Asian—Bangladeshi 1.3 (5) 0.8 (5)
Asian—other 2.6 (10) 1.7 (11)
Black/Black British
Black Caribbean 4.4 (17) 3.5 (23)
Black African 5.4 (21) 4.0 (26)
Black other 0.3 (1) 0.3 (2)
Chinese or other
Chinese 1.5 (6) 0.8 (5)
Other 0.8 (3) 1.4 (9)

*Field test 2 includes one woman who was continuing her pregnancy but miscarried in the 24 hours before
completing the measure. In field tests 1 and 2, 68 (94%) and 147 (99%) respectively were currently pregnant and
about to terminate their pregnancies. `In field tests 1 and 2, 54 (78%) and 177 (91%) respectively had a child
under 1 year.

encompassing a range of positions on each dimension (for
example, positive, negative, ambivalent) and by neither
requiring, nor assuming, congruence between dimensions.
In the follow up interviews, women were, overall,
extremely consistent in their descriptions of the circum-
stances in which they became pregnant; confirming many
features of their earlier interviews spontaneously. Only one
woman modified an aspect of her account (her contracep-
tive use) relating to the conceptual model. (In contrast,
greater change was noted regarding decision making after
confirmation of pregnancy, and the interviews showed that
women could clearly distinguish between their thoughts and
feelings about events leading to their pregnancies and their
thoughts and feelings about these events later, in light of
their new experiences.)
Development and piloting of items
Eleven items were developed from the conceptual model:
contraceptive use was represented by two items, personal
circumstances/timing by four, partner influences by two, and
the remaining dimensions by one item each. During piloting,
one item (relating to contraception) was separated into two
items, and minor changes to the wording and layout were
made.
Item analysis and selection
No item failed the threshold of .5% missing data. One ques-
tion failed the criterion of an endorsement frequency of over
80% on any one response option, hence was removed. Table 4
shows the inter-item and item-total correlations of the remain-
ing items. No item had an item-total correlation of ,0.2, and

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430 Barrett, Smith, Wellings

Table 3 Comparison of field test samples with national data

Field test 1 sample Field test 2 sample England and Wales, 2000*

Age Women opting for abortion (n = 71): Women opting for abortion (n = 146): Age at abortion (n = 175542):
% (n) % (n) % (n)
under 20 15.5 (11) 24.7 (36) 21.1 (36966)
20–24 29.6 (21) 26.7 (39) 26.8 (47099)
25–29 29.6 (21) 28.1 (41) 21.6 (37852)
30–34 15.5 (11) 9.6 (14) 16.4 (28735)
35–39 5.6 (4) 8.2 (12) 10.6 (18589)
40+ 4.2 (3) 2.7 (4) 3.6 (6253)
Age Women continuing Women continuing Age of mother at live birth
pregnancy (n = 247) pregnancy (n = 307): (n = 604441):
under 20 % (n) % (n) % (n)
20–24 5.7 (14) 11.4 (35) 7.6 (45846)
25–29 10.9 (27) 14.3 (44) 17.8 (107741)
30–34 24.7 (61) 18.6 (57) 28.2 (170701)
35–39 31.6 (78) 32.2 (99) 29.8 (180113)
40+ 23.5 (58) 20.2 (62) 14.1 (84974)
3.6 (9) 3.3 (10) 2.5 (15066)
Women continuing Women continuing Proportion of live births
pregnancy/postnatal pregnancy/postnatal women registered by married
women (n = 311): (n = 500): proportion who parents:
proportion who were were married:
married:
Total
% (n) % (n) % (n)
66.6 (207) 64.4 (322) 60.5 (365836)
By age group
under 20 0 (0) 9.8 (4) 10.3 (4742)
20–24 32.3 (10) 29.5 (18) 37.4 (40262)
25–29 63.0 (46) 66.0 (62) 65.4 (111606)
30–34 78.0 (78) 76.2 (138) 75.6 (136165)
35–39 81.6 (62) 84.5 (87) 73.8 (62671)
40+ 73.3 (11) 65.0 (13) 69.0 (10390)
Women continuing Women continuing Proportion of births
pregnancy/postnatal pregnancy/postnatal women registered by women who
women (n = 316): (n = 499): proportion who were born in the UK:
proportion who were were born in the UK:
born in the UK:
Total
% (n) % (n) % (n)
76.9 (243) 79.4 (396) 84.5 (510835)

*Office for National Statistics 200145 46; figures for Scotland similar but not shown.

applying the strategy of considering the inter-item correlations Acceptability

resulted in eight items (2, 4a, 4b, 4c, 4d, 6, 7, 8) being removed. After imputation of missing data, scores were available for
Cronbach’s a of the remaining three items was 0.78. To achieve all women in the sample. All scores were represented; 2.3%
an a of .0.90, three items (4b, 6, 7) were returned. of women scored the minimum (0) and 25.0% the maximum

Figure 1 Conceptual model of

pregnancy planning/unplanned
pregnancy.

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New measure of unplanned pregnancy 431

Key points
N A new, psychometrically evaluated, measure of
unplanned pregnancy is now available for use.
N The new measure is based on lay views, rather than
professional conceptualisations, of pregnancy plan-
ning.
N The measure is suitable for use with all women
regardless of (intended or actual) pregnancy outcome.
(12). The skew statistic was 20.4, however visual inspection of
the distribution suggested that the scores were negatively
skewed, possibly bimodal (with peaks at scores 2 and 12). The
readability level of the measure was 6.7 on the Flesch-Kincaid
grade level score (that is, suitable for an 11 year old), and most
women completed the measure in 60–90 seconds. The measure
was well received and did not cause offence.
Reliability
The Cronbach’s a was 0.92. (Item-total correlations ranged
from 0.60 to 0.89 and inter-item correlations ranged from
0.44 to 0.83.) For the standard test-retest the weighted k was
0.97, and for the long term test-retest it was 0.86.
Validity
Comparison of the six item measure with the conceptual model
showed that content validity had been maintained, with one
question representing each dimension of the model. All
hypotheses to test construct validity were supported (table 1),
suggesting that the scale is indeed measuring the degree to which
a pregnancy is planned. The results of principal component
analysis confirmed that all variables loaded onto one factor
(eigenvalue 4.33), with high factor loadings for each item: qu1-
0.70; qu2-0.90, qu3-0.93, qu4-0.90, qu5-0.89, qu6-0.75.
Interpreting the scores
The increasing scores of the measure (zero to 12) represent
increasing degrees of pregnancy planning/intention and there
are no obvious cut points in the scale; each score provides
additional information. In terms of producing population
estimates, we suggest (on the basis of preliminary inter-
pretation) the division of scores into a minimum of three
groups—that is,10–12 (planned), 4–9 (ambivalent); and 0–3
(unplanned).
DISCUSSION
We developed a six item measure of unplanned pregnancy.
Psychometric testing demonstrated the high internal con-
sistency, high stability (standard and longer term), and
excellent face, content, and construct validity of the measure.
One limitation is that for reasons of confidentiality, the
standard test-retest only included women who continued
their pregnancies, thus our assessment of test-retest relia-
bility does not provide any information about the stability
of the scale when used with women whose pregnancies
ended in abortion. Interestingly, the findings of the long
term test-retest (and the qualitative follow up interviews)
directly contradict previous evidence concerning the
stability of women’s reports of pregnancy planning after
birth.25 26 The reason for this may be that the items of the
measure permit women a wider range of answers and
therefore do not force women into categories that may be
invalid. The measure was developed in Britain and is
therefore appropriate for use with this population. As with
other measures, re-validation would be required before
application to other countries.
Compared with previous questions used to assess preg-
nancy planning, the measure has a number of advantages: it
makes no assumptions about the nature of women’s
relationships; it does not rely on women having fully formed
childbearing plans; it does not assume a particular form of
family building; and it is suitable for use with any pregnancy
regardless of outcome. Because of its conceptual basis, the
measure does not presume that women have clearly defined
intentions and/or behaviour consistent with intentions.
Women may occupy a range of positions in relation to
pregnancy planning, and these are represented by the range
of scores from zero to 12. The scores also provide more
sophisticated information about pregnancy planning than the
Policy implications
N Unplanned pregnancy is often used as a proxy
indicator of poor sexual health, and reducing the
number of unplanned pregnancies is a policy aim of
many countries around the world, including the USA
and the UK.
N Existing methods of eliciting pregnancy planning status
have become dated.
N A new measure will facilitate the production of reliable
estimates of unplanned pregnancy.

Table 4 Inter-item and item-total correlations

Inter-item correlations:

q1 (1)* 1.0
q2 0.7924 1.0
q4a 0.4792 0.4636 1.0
q4b (2) 0.4998 0.4228 0.7811 1.0
q4c 0.5268 0.4858 0.7503 0.7481 1.0
q4d 0.4328 0.4164 0.7458 0.7064 0.8317 1.0
q5 (3) 0.6080 0.5808 0.7172 0.7453 0.6815 0.6633 1.0
q6 (4) 0.5170 0.4688 0.7317 0.8140 0.6870 0.6859 0.8137 1.0
q7 (5) 0.5292 0.4955 0.7225 0.7592 0.7285 0.6670 0.8042 0.7645 1.0
q8 0.4807 0.4395 0.7025 0.6934 0.6784 0.6303 0.6976 0.7259 0.7824 1.0
q9 (6) 0.4134 0.3790 0.5125 0.5351 0.4773 0.4646 0.6241 0.5464 0.5564 0.5446 1.0
q1(1) q2 q4a q4b(2) q4c q4d q5(3) q6(4) q7(5) q8 q9(6)
Item-totals 0.6369 0.5915 0.8210 0.8354 0.8157 0.7716 0.8641 0.8429 0.8498 0.7892 0.6165

*Figures in parentheses correspond to item numbers of the measure (appendix, available to view on the journal web site http://www.jech.com/supplemental).
An item-total correlation is the correlation of the individual item with the scale total omitting that item.

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432
dichotomous categories of planned and unplanned. The
measure is short (only six items) and highly acceptable
(that is, easy to understand, inoffensive, and quick to
complete), attributes that make it suitable for use in large
scale surveys.
The measure, with its conceptual basis, represents a
clear break with the forms of measurement found in
the previous British surveys and the current US and
Demographic and Health Surveys (the last being the main
data source of the international family planning move-
ment). As such, the measure avoids the assumption that
members of modern (post-demographic transition) societies
are universally rational and instrumental in terms of their
fertility decisions and control; an assumption that some
have seen as characterising research on fertility and fertility
change in the 20th century.48 49 Instead, the measure
permits representation of a range of positions (for
example, actions congruent with intentions, actions incon-
sistent with intentions, ambivalence in fertility intentions
and actions, etc), thereby providing a more complex and
realistic of portrayal of human fertility behaviour than
existing questions.
ACKNOWLEDGEMENTS
We wish to acknowledge the valuable contribution of our project
collaborators: Lynne Cho, Karen Dunnell, Penny Edgington, Elaine
Fisher, Anna Glasier, Isaac Manyonda, Stanley Okolo, Catherine
Paterson, Connie Smith, and R William Stones. We would also like to
thank the many others who have helped with this project, including:
Maureen Batley, Audrey Brown, Jill Brown, Jenny Charman, Carrie
Free, Rolla Khadduri, Patricia Kingori, Sunethra Kossine, Maya
Malalgoda, Janet Peacock, Jan Sanders, Margaret Thorogood, Ros
Tolcher, and Maddy Ward.
The appendix is available to view on the journal web
site (http://www.jech.com/supplemental).
.....................
Authors’ affiliations
G Barrett, K Wellings, Centre for Sexual and Reproductive Health
Research, Department of Public Health and Policy, London School of
Hygiene and Tropical Medicine, University of London, London, UK
S C Smith, Health Services Research Unit, Department of Public Health
and Policy, London School of Hygiene and Tropical Medicine, University
of London
Funding: this project was supported by a Medical Research Council/
London Region special training fellowship in Health Services Research
Conflicts of interest: none declared.
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THE JECH GALLERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

doi: 10.1136/jech.2003.008730
Influential women in occupational health
Lynn R Goldman, MD—Paediatrician, Professor, and Epidemiologist

April 1951–, Country of birth: USA

L
ynn Goldman has extensive background in pesticide and environmental risks to children.
During her tenure as Assistant Administrator for Prevention, Pesticides and Toxic
Substances at the US Environmental Protection Agency (EPA), she was responsible for
the nation’s toxic chemicals regulatory programmes. There she expanded citizens’ right to
know under the Toxics Release Inventory, and updated the US pesticides laws. Goldman made
progress on testing of high volume industrial chemicals and identification of chemicals that
disrupt endocrine systems. She was also successful in promoting children’s health issues,
furthering the international agenda for global chemical safety.

‘‘The environment has been taken out of public health and put into environmental
agencies, and environmental agencies have lost touch with health.’’

With globalisation, Goldman recognises the increasing importance of chemical safety and
biotechnology to public health. Her work involves development of policy. At Johns Hopkins
University, she co-chairs the school-wide taskforce on bioterrorism.

D F Salerno
Clinical Communications Scientist, Pfizer Global Research and Development, Ann Arbor
Laboratories, Ann Arbor, MI, USA
I L Feitshans
Adjunct Faculty, Cornell University, School of Industrial and Labor Relations, Albany, NY, USA

Correspondence to: Deborah F. Salerno, 2800 Plymouth Road, Ann Arbor, MI 48105, USA;
deborah.salerno@pfizer.com

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